Repair of an endoscopic submucosal dissection-induced rectal perforation with band ligation

Department of Internal Medicine, Hallym University College of Medicine, Anyang, Korea.
Gastrointestinal endoscopy (Impact Factor: 4.9). 02/2009; 69(1):160-1; discussion 161. DOI: 10.1016/j.gie.2008.07.008
Source: PubMed
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    ABSTRACT: Background: GI perforations occur rarely during endoscopy but have life-threatening implications. Objective: To evaluate endoscopic band ligation (EBL) for closure of acute GI perforations by using a porcine model. Design: Investigator-initiated interventional pilot study by using an in vivo porcine model. Setting: Tertiary-care institution. Subjects: Ten domestic pigs. Intervention: Each animal underwent a single endoscopic procedure, with creation of a single GI lumen perforation. Perforations of 10 to 20 mm were created in the esophagus, stomach, duodenum, and colon. EBL was used for closure. Fourteen days later, the pigs were killed, microbial cultures were obtained, and histologic review was done. Main Outcome Measurements: Immediate and delayed endoscopic closure of the perforation site, evidence of clinical peritonitis during the 14-day follow-up. Results: Ten pigs completed the protocol and survived without clinical peritonitis during the 14-day follow-up. Endoscopic closure of a 15-mm esophageal perforation failed, thus, no attempt was made to close a 20-mm esophageal perforation. Closure of all other perforations was successful. At necropsy, fibrinous peritonitis was suspected in one animal with a 10-mm duodenal perforation. Chronic inflammation and fibroplasia at the perforation sites were the most common histologic findings. Limitations: The applicability of widespread use in humans remains unknown despite successful case reports in the medical literature. Conclusion: EBL can be used successfully to close 10 to 20 mm perforations within normal stomach, duodenum, and colon and can prevent clinically relevant intra-abdominal infections. However, for esophageal perforations, closure may be limited to small (<= 10 mm), iatrogenic perforations.
    Gastrointestinal Endoscopy 07/2014; 80(4). DOI:10.1016/j.gie.2014.06.014 · 4.90 Impact Factor
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    ABSTRACT: Recent reports have indicated several instances of successful treatment of bowel perforation by using endoscopic band ligation (EBL) when treatment with endoclipping is unsuccessful, but this salvage method has not been investigated in any prospective model. Herein we aimed to compare the technical feasibility and efficacy of EBL and endoclip use in intraluminal closure of colon perforation, in an ex vivo model. Standardized colonic perforations were created using fresh porcine colon and subsequently closed by full-thickness interrupted sutures, endoclip (QuickClip2(TM) ), or EBL. Each closure site was tested with compressed air by using a digital pressure monitor for evaluating leak pressure. No significant differences were noted between the endoclip and EBL in leak pressures. Mean (± SD) pressures for air leakage from the perforations closed using the different devices were as follows: normal colon samples, 52.0 ± 13.2 mmHg; perforations closed with hand-sewn sutures, 32.3 ± 8.3 mmHg; perforations closed with endoclipping, 53.5 ± 22.7 mmHg; and perforations closed with EBL, 50.4 ± 12.5 mmHg. Time taken for closure by EBL was significantly less than that for closure by endoclipping (3.2 ± 1.7 min vs 6.8 ± 1.3 min, P < 0.01). Further, the number of devices used to achieve complete closure in the EBL group was lower than that with endoclipping (1.6 ± 0.5 vs 3.7 ± 0.8, P < 0.01). Endoluminal closure of a 1.5-cm colon perforation with EBL decreased procedure time and was not inferior in leak pressure compared with endoclipping in this ex vivo porcine model.
    Digestive Endoscopy 03/2014; 26(5). DOI:10.1111/den.12266 · 1.99 Impact Factor
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    ABSTRACT: Endoscopic band ligation (EBL) is the preferred endoscopic technique for the endoscopic treatment of acute esophageal variceal bleeding. EBL has also been used to treat nonvariceal bleeding. Recently, Han et al demonstrated that EBL can be a feasible and safe alternate technique for the management of iatrogenic gastric perforation especially in cases in which closure with endoclips is difficult. EBL is technically simpler to perform than other methods and provides a good view of the lesions under direct pressure and suction from the transparent ligation cap. EBL can be used even if the diameter of the perforation is greater than 10 mm or if there is a severe tangential angle. In this commentary, we discuss the efficacy and safety of EBL for the closure of iatrogenic gastrointestinal perforation. We also discuss the advantages and disadvantages of EBL for the treatment of nonvariceal bleeding.
    World Journal of Gastroenterology 07/2013; 19(27):4271-6. DOI:10.3748/wjg.v19.i27.4271 · 2.43 Impact Factor